Long‐term effects of homelessness on mortality: a 15‐year Australian cohort study

To examine the effect of homelessness on mortality. This 15‐year retrospective longitudinal cohort study compared mortality outcomes of homeless and non‐homeless adults attending the emergency department of an inner‐city public hospital in Melbourne, Victoria between 1 January 2003 and 31 December 2004. Homeless individuals had ≥1 recorded episodes of homelessness within the recruitment period, categorised by type: primary, secondary, tertiary, marginally housed. Non‐homeless individuals were stably housed throughout. Over 15 years, homeless individuals had a higher mortality rate (11.89 vs. 8.10 per 1,000 person‐years), significantly increased mortality risk (rate ratio 1.47, 95% confidence interval [CI] 1.26–1.71) and younger median age at death (66.60 vs. 78.19 years) compared to non‐homeless individuals. Using adjusted Cox proportional hazards models, primary (hazard ratio [HR] 2.05, 95%CI 1.67–2.50), secondary (HR 1.60, 95%CI 1.23–2.10) and tertiary (HR 1.72, 95%CI 1.16–2.56) homelessness were independent risk factors for premature mortality. At least one recorded episode of primary, secondary, or tertiary homelessness was associated with premature mortality and younger age at death over a 15‐year period. Accurately identifying individuals experiencing primary, secondary or tertiary homelessness at the emergency department may enable targeted interventions that could potentially reduce their risk of premature mortality.